Vision for a More Effective Medical Curriculum in the Philippines

Thank you

Honor and Privilege

Speaker

Everybody has a vision for something.

You have a vision for something.

I also have a vision.

Dr. Rodolfo Dimayuga has a vision.

Personal Vision/Aspirations

for a

More Effective Medical Curriculum

in the Philippines

Reynaldo O. Joson, MD, MHPEd, MHA, MS Surg

2001

“More Effective”

Medical Curriculum in the Philippines

To avoid critics making such comments as -

“Why what’s wrong with the present medical curriculum in the Philippines?”

“Who are you to say that the present medical curriculum in the Philippines is NOT effective?”



Premise -

In everything,

there is always room for improvement!



Use in a general sense

BETTER! SOMETHING BETTER!



Used encompassingly -

“greater chance of achieving the goal and objectives of the medical curriculum in an efficient, relevant, student-friendly manner as well as other BETTER attributes”



With this clarification and declaration of intention,

HOPEFULLY, I will NOT be causing undue AGITATION

among my colleagues in the medical profession, especially those who are more senior than I am and those who have years of experience teaching in and managing medical schools.

DREAM MUST BE GOOD, NOT BAD!

VISION

Two triggers:

1. The experience itself , that is, being exposed to the situation

2. Desiring something better, that is, after discovering some dissatisfaction with the situation

What brought about my

Personal Vision/Aspirations

for a

More Effective Medical Curriculum

in the Philippines?

What brought about my Personal Vision/Aspirations for a More Effective Medical Curriculum in the Philippines?

1st trigger for a vision - the experience itself, that is, being exposed to the situation

medical curriculum in the Philippines


1st trigger - experience and exposure to the medical curriculum in the Philippine

1st exposure and 1st hand experience -

Studied medicine in UPCM (1970-1974)

Rotating internship in PGH (1975)



1976 -1981 : Continued exposure - “loose, secondary, unintentional”

Focus: General Surgery Residency - PGHContact with med students rotating in surgery

ABLE TO ASSESS IMPACT OF CURRICULUM



1982 -1993: Continued exposure - Faculty: UPCM / PGH (General Surgery)Supervising Medical Training Officer - OM (1992-

1999)

ABLE TO ASSESS IMPACT OF CURRICULUM



1994 -2001: Continued exposure - Faculty: UPCM / PGH (General Surgery)

Supervising Medical Training Officer - OM (1992-1999)Educational Consultant of med schools

Zamboanga Medical School (1994-1997)Southwestern University CM (1995-2000)Bicol Christian CM (1995-2001-)

INS AND OUTS / IMPACT OF CURRICULUM



Length of Exposure - 30 YEARS (1970-2000)

INS AND OUTS / IMPACT OF CURRICULUM IN THE PHILIPPINES


2nd trigger for a vision - desiring something better after discovering some dissatisfaction with the situation

2 situations - to take a close look at medical curriculumto target it as a root cause for all the problems we

are having in the medical professiontherefore, to aspire for its change or improvement



1st situation:

1982 to 1993, as a surgical educator of residents in the Philippine General Hospital, Ospital ng Maynila, Zamboanga City Medical Center, Tondo Medical Center, and other residents throughout the country,



1982 to 1993, as an educator of surgical residents

I discovered - a lot of “ill habits, attitude and practices” in medical reasoning, decision-making and continuing education whose root could be traced in the earlier part of

residency training and even as far back as the medical school years.



After more than 10 years of perseverently teaching surgical residents, got burnt out and decided that I should target root cause, which I considered to be the medical curriculum at the medical school level.



Thus, in 1994, when I had the opportunity to design the curriculum for a new medical school, I did not hesitate to accept the challenge.



I helped design the innovative medical curriculum of Zamboanga Medical School Foundation.

This curriculum was later adopted by Southwestern University College of Medicine in 1995 and Bicol Christian College of Medicine, also in the same year.



2nd situation:

From 1989 to present, as a hospital administrator of Manila Doctors Hospital in my capacity as an assistant medical director and chairperson of quality assurance program,



I discovered a lot of “ill-habits, attitude and practices”, not to say, incompetences, not only in medical reasoning and decision-making among consultant staff but also in their way of managing a hospital unit or department assigned to them.



Again, I attributed the root cause to be at the medical school years level.



There are only a few medical schools in the country that incorporate management course in their curricula.

If only physician-managership can be developed, hospitals will be easier to manage by physician-administrators.



There are quite a number of irrational, ineffective, inefficient, and inhumane physicians and specialists in our midst.

We can reduce the amount of bad products if we improve the medical curriculum.



Areas of Dissatisfaction

1. Present medical schools and their curricula have NO documented direct and significant impact on the health development in the country.



Areas of Dissatisfaction

2. A lot of things in the present medical curricula are not relevant.

3. Present medical curricula are NOT student-friendly.

4. Present medical curricula are NOT efficient.


1a. Present medical schools are contented merely with graduates passing the board.

1b. Present medical schools consider that with production of board-certified physicians

and with the latter practicing in the country, they have already contributed to the health

development in the country.


1c. Present medical schools consider incorporating a community immersion subject a way of

contributing to the health development in the country.

1d. Present medical schools do not work closely with the Department of Health which is the main agency in charge of health development in the country. They should incorporate the health programs of DOH into their curricula.

My vision and aspiration:

Medical schools and their curricula should have documented direct

and significant impact on the health development in the

country.

My vision and aspiration:

They should go beyond producing board-passers, community

immersion, and should work closely with DOH by incorporating the latter programs in their curricula.

In the curriculum which I designed,

1. the DOH health programs are incorporated and implemented in their community

immersion.

2. as part of the requirement for graduation, the students with the help of the faculty

should solve (at least attempt) one health problem in their assigned community formally documented through an action research.

With the above 2 strategies, at the end of the day, the medical school can say that with its

medical curricula, it has contributed to the health development in the country.


2a. Students are taught things that are uncommon in the country.

2b. Students are taught things which are NOT used in clinical practice.

Example: Students are taught traditional medical recording which is NOT done by certified physicians.


2c. Students are NOT taught effective “study methods” of certified

physicians, which is in the form of problem-based learning.

My vision and aspirations:

Medical curricula should be relevant.

In the curriculum I designed, students are taught

1. common things found in the country2. things used in clinical practice

3. problem-based learning method

4. Present medical curricula are NOT student-friendly.

4a. There is NO standardization of “processes” such as and especially, management of a patient process; teaching-learning process, and managerial process

4b. There is NO coordination of various disciplines.


Medical curricula should be student-friendly.

In the curriculum I designed, there is

1. Standardization of processes, especially, management of a patient process.

2. Standardization of learning method – problem-based learning.


Medical curricula should be student-friendly.

In the curriculum I designed, there is

3. Standardization of managerial process – there is a framework that is being

used all throughout the course.

4. Integration and coordination among various disciplines.

4. Present medical curricula are NOT efficient.

This is a result of the problems identified in No. 3 associated with the medical

curricula NOT being student-friendly.

Standardization, using framework, and integration and coordination

among various disciplines contribute to efficiency.

Thus far here in my talk,

I have told you the two triggers that led me to a vision/aspirations for a more effective medical curriculum in the Philippines:

•30-years of exposure to the situation •discovery of dissatisfaction with the present

medical curricula.

I have also partly described to you my vision and what I have done to pursue it.

As I said earlier, I started pursuing my vision for a more effective medical curriculum in the Philippines in 1994 when I designed a curriculum for Zamboanga Medical School Foundation.

I shall now describe to you in detail the curriculum that I designed in pursuit of my vision as well as other activities that I did, again in pursuit of this vision.

R.O. Joson’sMedical Curriculum Model

A vertically integrated curriculum

community-oriented-based learningcompetency-based learningproblem-based learningdistance learning

vertically individual health management learning

community health management learningintegrated

biophysical issues learningcurriculum psychosocial issues learning

bioethical issues learningmedicolegal issues learningresearch issues learning

basic medical sciencesclinical medical sciences

R.O. Joson’s Medical Curriculum Model

Used by Zamboanga Medical School Bicol Christian College of MedicineSouthwestern University CM

Will be used by CSI-CM (Naga City) - 2001


Indigenously Filipino model

Uniquely created by a Filipino

Chosen problems are commonly seen in Philippines

Learning content are Phil-based and Filipino-culture based


Unique in the sense that it uses

Chief complaints as initial triggers rather than vignettes

Forward reasoning rather than backward reasoning in the problem-solving process


Unique in the sense that it integrates

Community-based, competency-based, problem-based, and Distance learning

Individual and community health management learning

Biophysical, psychosocial, bioethical, medicolegal, and research issues learning

Basic and clinical medical sciences learning


Yr Sem Phase Courses CommunityImmersion

I 1st Orientation /Introduction

Orientation to Schooland Community;Physician-to-bePlanning;Management inMedicine; How toStudy (PBL)



I 1st Competenciesof an MD

Health Management Ind’l Health Mgt Family Health Mgt Com’ty Health MgtMgt of a Patient Screening for health problem Solution of a health problemMD-Teacher-learnerMD-ResearcherMD-AdministratorEmergency Medicine



I 1st CommunityHealthManagementI

CommunityDiagnosis4-yearComprensiveCommunityHealth Plan



I 2nd DOH PriorityHealthProblems

TraumaMaternal and Child HealthCancer


Yr Sem Phase Courses Community Immersion

I 2nd CommunityHealthManagementII

Action Research Proposalfor an Identified HealthProblem in the Communityusing Primary Health CareApproach



II 1st –2nd

Organ/SystemProblems

Cardiovascular;Pulmonary;Abdominal; Nervous;Mind; EENT



II 1st –2nd

CommunityHealthManagementIII and IV

Implementationof ActionResearchProposalAnd CommunityHealth Plan



III 1st Organ/SystemProblems

Renal; Skin and SoftTissues; Bone andJoint; Hematologic /Immunologic;Sexuality



III 1st CommunityHealthManagementV




III 2nd HospitalImmersion

Pediatrics; InternalMedicine; Surgery;Obstetrics-Gynecology



III 2nd CommunityHealthManagementVI




IV 1st –2nd

Elective Hospital rotation;specialty rotation;others



IV 1st -2nd

CommunityHealthManagementVII


R.O. Joson’s PBL ModelFeatures

Learning Courses and Modules:

Simulated and Actual Patients/Communities

Initial triggers for individual patient management:

chief complaint (not vignettes)

Forward-reasoning model

R.O. Joson’s PBL Model

Preliminary Discussions for Courses/Modules:

Courses on MD’s CompetenciesConcept of competenciesCompetencies needed by a physician-to-beAsssessment of present competenciesHow to learn the needed competenciesHow to evaluate

R.O. Joson’s PBL Model

Preliminary Discussions for Courses/Modules:

Health Problems (e.g. trauma, cancer, cardiovascular, pulmonary, mind, nervous, sexuality, etc.)

• Concept of health problems• Common types• Common causes• Magnitude of the health problems• Common chief complaints • Personal perspective on how to solve the problem in the

community using a primary health care approach• Competencies needed to learn / learning topics• Learning plan



Basic Design:

Framework Foundation Development Mastery



General Principles of Management Framework

How to Study Framework (PBL)

Health Management Framework

Management of a Patient Framework

Primary Health Care Framework

Date post:	13-Apr-2017
Category:	Health & Medicine
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Vision for a More Effective Medical Curriculum in the Philippines

Health & Medicine